Amiga Plus 1995 #2/Amiga Plus CD - 1995 - No. 2.iso/internet/faq/englisch/alt.support.depression

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Archive-name: alt-support-depression/faq/part1
Posting-Frequency: bi-weekly
Last-modified: 1994/08/07


alt.support.depression FAQ
==========================


Introduction
------------

Alt.support.depression is a newsgroup for people who suffer from all
forms of depression as well as others who may want to learn more about
these disorders. Much the information shared in this newsgroup comes
from posters' experience as well as contributions by professionals in
many fields. The thoughts expressed here are for the benefit of the
readers of this group. Please be considerate in the way you use the
information from this group, keeping in mind the stigma of depression
still experienced in society today.

The following Frequently-Asked-Questions (FAQ) attempts to impart an
understanding of depression including its causes; its symptoms; its
medication and treatments--including professional treatments as well as
things you can do to help yourself. In addition, information on where to
get help, books to read, a list of famous people who suffer from
depression, internet resources, instructions for posting anonymously,
and a list of the many contributors is included.

Updated and corrected versions will be posted periodically. Please send
suggestions to <[e-mail]>.

This FAQ, and many other FAQ's, are available via anonymous ftp from
<rtfm.mit.edu>. To get the latest edition of this FAQ:
ftp://rtfm.mit.edu/pub/usenet/news.answers/alt-support-depression/faq/part1

The directory and file name is located in the "Archive-name:" line in
the header. A mail server also exists for accessing the FAQ archives.
Send a message to <[e-mail]>, with the command "help"
in the body of your message.


Table of Contents
=================

Key:
     - No change.
     + Added since last posting.
     & Updated since last posting.


Part 1 of 5
-----------

 **Depression Primer**

  **Types**
   - What is depression?
   - What is major depression?
   - What is dysthymia?
   - What is bipolar depression (manic-depressive illness)?
   - What is Seasonal Affective Disorder (SAD)?
   - What is Post Partum Depression
   - How is bereavement different from depression?
   - What is Endogenous Depression
   - What is atypical depression?

  **Symptoms**
   - What are the typical symptoms of depression?
   - What are the diagnostic criteria for depression?

  **Causes**
   - What causes depression?


Part 2 of 5
-----------

  **Causes** (cont.)
   - What initiates the alteration in brain chemistry?
   - Is a tendency to depression inherited?

  **Treatment**
   - What sorts of psychotherapy are effective for depression?

  **Medication**
   - Do certain drugs work best with certain depressive illnesses? What
     are the guidelines for choosing a drug?
   - How do you tell when a treatment is not working? How do you know
     when to switch treatments?
   - How do antidepressants relieve depression?
   - Are Antidepressants just "happy pills?"
   - What percentage of depressed people will respond to
     antidepressants?
   - What does it feel like to respond to an antidepressant? Will I
     feel euphoric if my depression responds to an antidepressant?
   - What are the major categories of anti-depressants?
   - What are the side-effects of some of the commonly used
     antidepressants?
   - What are some techniques that can be used by people taking
     antidepressants to make side effects more tolerable?
   - Many antidepressants seem to have sexual side effects. Can
     anything
     be done about those side-effects?
   - What should I do if my antidepressant does not work?


Part 3 of 5
-----------

  **Medication** (cont.)
   - If an antidepressant has produced a partial response, but has not
     fully eliminated depression, what can be done about it?

  **Electroconvulsive Therapy**
   - What is electroconvulsive therapy (ECT) and when is it used?
   - Exactly what happens when someone gets ECT?
   - How do individuals who have had ECT feel about having had the
     treatments?
   - How long do the beneficial effects of ECT last?
   - Is it true that ECT causes brain damage?
   - Why is there so much controversy about ECT?

  **Substance Abuse**
   - May I drink alcohol while taking antidepressants?
   - If I plan to drink alcohol while on medication, what precautions
     should I take?
   - What's the relationship between depression and recovery from
     substance abuse?
   - What does the term "dual-diagnosis" mean?
   - Is it safe for a person recovering from substance abuse to take
     drugs?
   - How do you know when depression is severe enough that help should
     be sought?

  **Getting Help**
   -Where should a person go for help?
   -Where can I find help in the United Kingdom?
   -Where can I find out about support groups for depression?
   -How can family and friends help the depressed person?

  **Choosing A Doctor**
   -What should you look for in a doctor? How can you tell if he/she
    really understands depression?

  **Self-care**
   - How may I measure the effects my treatment is having on my
     depression?

Part 4 of 5
-----------

  **Self-care** (cont.)
   - How can I help myself get through depression on a day-to-day
     basis?

  **Books**
   - What are some books about depression?

Part 5 of 5
-----------

  **Famous People**
   - Who are some famous people who suffer from depression and bipolar
     disorder?

  **Internet Resources**
   - What are some electronic resources on the internet related to
     depression?

  **Anonymous Posting**
   - How can I post anonymously to alt.support.depression?

  **Sources**
   - Sources

  **Contributors**
   - Contributors


Depression Primer
=================

Types
-----

Q. What is depression?

   Being clinically depressed is very different from the down type of
   feeling that all people experience from time to time. Occasional
   feelings of sadness are a normal part of life, and it is
   that such feelings are often colloquially referred to as
   "depression." In clinical depression, such feelings are out of
   proportion to any    external causes. There are things in everyone's
   life that are possible causes of sadness, but people who are not
   depressed manage to cope with these things without becoming
   incapacitated.

   As one might expect, depression can present itself as feeling sad or
   "having the blues". However, sadness may not always be the dominant
   feeling of a depressed person. Depression can also be experienced as
   a numb or empty feeling, or perhaps no awareness of feeling at all.
   A depressed person may experience a noticeable loss in their ability
   to feel pleasure about anything. Depression, as viewed by
   psychiatrists, is an illness in which a person experiences a marked
   change in their mood and in the way they view themselves and the
   world. Depression as a significant depressive disorder ranges from
   short in duration and mild to long term and very severe, even life
   threatening.

   Depressive disorders come in different forms, just as do other
   illnesses such as heart disease. The three most prevalent forms are
   major depression, dysthymia, and bipolar disorder.


Q. What is major depression?

   Major depression is manifested by a combination of symptoms (see
   symptom list below) that interfere with the ability to work, sleep,
   eat; and enjoy once-pleasurable activities. These disabling episodes
   of depression can occur once, twice, or several times in a lifetime.


Q. What is dysthymia?

   A less severe type of depression, dysthymia, involves long-term,
   chronic symptoms that do not disable, but keep you from functioning
   at "full steam" or from feeling good. Sometimes people with dysthymia
   also experience major depressive episodes.


Q. What is bipolar depression (manic-depressive illness)?

   Another type of depressive disorder is manic-depressive illness, also
   called bipolar depression. Not nearly as prevalent as other forms of
   depressive disorders, manic depressive illness involves cycles of
   depression and elation or mania. Sometimes the mood switches are
   dramatic and rapid, but most often they are gradual. When in the
   depressed cycle, you can have any or all of the symptoms of a
   depressive disorder. When in the manic cycle, any or all symptoms
   listed under mania may be experienced. Mania often affects thinking,
   judgment, and social behavior in ways that cause serious problems and
   embarrassment. For example, unwise business or financial decisions may
   be made when in a manic phase.


Q. What is Seasonal Affective Disorder (SAD)?

   SAD is a pattern of depressive illness in which symptoms recur every
   winter. This form of depressive illness often is accompanied by such
   symptoms as marked decrease in energy, increased need for sleep, and
   carbohydrate craving. Photo therapy - morning exposure to bright, full
   spectrum light - can often be dramatically helpful.


Q. What is Post Partum Depression?

   Mild moodiness and "blues" are very common after having a baby, but
   when symptoms are more than mild or last more than a few days, help
   should be sought. Post part depression can be extremely serious for
   both mother and baby.


Q. How is bereavement different from depression?

   A full depressive syndrome frequently is a normal reaction to the
   death of a loved one (bereavement), with feelings of depression and
   such associated symptoms as poor appetite, weight loss, and insomnia.
   However, morbid preoccupation with worthlessness, prolonged and
   marked functional impairment, and marked psychomotor retardation are
   uncommon and suggest that the bereavement is complicated by the
   development of a Major Depression. The duration of "normal"
   bereavement varies considerably among different cultural groups.


Q. What is Endogenous Depression?

   A depression is said to be endogenous if it occurs without a
   particular bad event, stressful situation or other definite, outside
   cause being present in the person's life. Endogenous depression
   usually responds well to medication. Some authorities do not consider
   this to be a useful diagnostic category.


Q. What is atypical depression?

  "Atypical depression" is not an official diagnostic category, but it
   is often discussed informally. A person suffering from atypical
   depression generally has increased appetite and sleeps more than usual.
   An atypical depressive may also be able to enjoy pleasurable
   circumstances despite being unable to seek out such circumstances.
   This contrasts with the "typical" depressive, who generally has
   reduced appetite and insomnia, and who is often unable to find
   pleasure in anything. Despite its name, atypical depression may in
   fact be more common than the other kind.


Symptoms
--------

Q. What are the typical symptoms of depression?

   A depressive disorder is a "whole-body" illness, involving your body,
   mood, and thoughts. It affects the way you eat and sleep, the way you
   feel about yourself, and the way you think about things. A depressive
   disorder is not a passing blue mood. It is not a sign of personal
   weakness or a condition that can be willed or wished away. People
   with a depressive illness cannot merely "pull themselves together" and
   get better. Without treatment, symptoms can last for weeks, months, or
   years. Appropriate treatment, however, can help over 80% of those who
   suffer from depression. Bipolar depression includes periods of high
   or mania. Not everyone who is depressed or manic experiences every
   symptom. Some people experience a few symptoms, some many. Also,
   severity of symptoms varies with individuals.

   Symptoms of Depression:

   * Persistent sad, anxious, or "empty" mood
   * Feelings of hopelessness, pessimism
   * Feelings of guilt, worthlessness, helplessness
   * Loss of interest or pleasure in hobbies and activities that you
     once enjoyed, including sex
   * Insomnia, early-morning awakening, or oversleeping.
   * Appetite and/or weight loss or overeating and weight gain
   * Decreased energy. fatigue, being "slowed down"
   * Thoughts of death or suicide, suicide attempts
   * Restlessness, irritability
   * Difficulty concentrating, remembering, making decisions
   * Persistent physical symptoms that do not respond to treatment, such
     as headaches, digestive disorders, and chronic pain

   Symptoms of Mania:

   * Inappropriate elation
   * Inappropriate irritability
   * Severe insomnia
   * Grandiose notions
   * Increased talking
   * Disconnected and racing thoughts
   * Increased sexual desire
   * Markedly increased energy
   * Poor judgment
   * Inappropriate social behavior


Q. What are the diagnostic criteria for depression?

   Depression comes in many forms and in many degrees. Below, you will
   find some of the most common depressive types, along with some of the
   diagnostic criteria from the DSM-III-R (the official diagnostic and
   statistical manual for psychiatric illnesses).

   **Major Depression:** This is a most serious type of depression. Many
   people with a major depression can not continue to function normally.
   The treatments for this are medication, psychotherapy and, in extreme
   cases, electroconvulsive therapy (ECT).

   Diagnostic criteria:
   A. At least five of the following symptoms have been present during
      the same two-week period and represent a change from previous
      functioning; at least one of the symptoms is either (1) depressed
      mood, or (2) loss of interest or pleasure. (Do not include
      symptoms that are clearly due to a physical condition, mood-
      incongruent delusions or hallucinations, incoherence, or marked
      loosening of associations.)
      1. depressed mood most of the day, nearly every day, as indicated
         either by subjective account or observation by others
      2. markedly diminished interest or pleasure in all, or almost all,
         activities most of the day, nearly every day (as indicated
         either by subjective account or observation by others of apathy
         most of the time)
      3. significant weight loss or weight gain when not dieting (e.g.
         more than 5% of body weight in a month), or decrease or
         increase in appetite nearly every day
      4. insomnia or hypersomnia nearly every day
      5. psychomotor agitation or retardation nearly every day
         (observable by others, not merely subjective feelings of
         restlessness or being slowed down)
      6. fatigue or loss of energy nearly every day
      7. feelings of worthlessness or excessive or inappropriate guilt
         (which may be delusional) nearly every day (not merely self-
         reproach or guilt about being sick)
      8. diminished ability to think or concentrate, or indecisiveness
         nearly every day (either by subjective account or as observed
         by others)
      9. recurrent thoughts of death (not just fear of dying), recurrent
         suicidal ideation without a specific plan, or a suicide attempt
         or a specific plan for committing suicide
   B. (1) It cannot be established that an organic factor initiated and
      maintained the disturbance (2) The disturbance is not a normal
      reaction to the death of a loved one
   C. At no time during the disturbance have there been delusions or
      hallucinations for as long as two weeks in the absence of
      prominent mood symptoms (i.e..- before the mood symptoms
      developed or after they have remitted).
   D. Not superimposed on Schizophrenia, Schizophreniform Disorder,
      Delusional Disorder, or Psychotic Disorder

   **Dysthymia:** This is a mild, chronic depression which lasts for two
   years or longer. Most people with this disorder continue to function
   at work or school but often with the feeling that they are "just
   going through the motions." The person may not realize that they are
   depressed. Anti-depressants or psychotherapy can help.

   Diagnostic criteria:
   A. Depressed mood (or can be irritable mood in children and
      adolescents) for most of the day, more days than not, as indicated
      either by subjective account or observation by others, for at
      least two years (one year for children and adolescents)
   B. Presence, while depressed, of at least two of the following:
      1. poor appetite or overeating
      2. insomnia or hypersomnia
      3. low energy or fatigue
      4. low self-esteem
      5. poor concentration or difficult making decisions
      6. feelings of hopelessness
   C. During a two-year period (one-year for children and adolescents)
      of the disturbance, never without the symptoms in A for more than
      two months at a time.
   D. No evidence of an unequivocal Major Depressive Episode during the
      first two years (one year for children and adolescents) of the
      disturbance.
   E. Has never had a Manic Episode or an unequivocal Hypo manic
      Episode.
   F. Not superimposed on a chronic psychotic disorder, such as
      Schizophrenia or Delusional Disorder.
   G. It cannot be established that an organic factor initiated or
      maintained the disturbance, e.g., prolonged administration of an
      antihypertensive medication.

   **Adjustment Disorder with Depressed Mood:** This is the type of
   depression that results when a person has something bad happen to
   them that depresses them. For example, loss of one's job can cause
   this type of depression. It generally fades as time passes and the
   person gets over what ever it was that happened.

   Diagnostic criteria:
   A. A reaction to an identifiable psycho social stressor (or multiple
      stressors) that occurs within three months of onset of the
      stressor(s).
   B. The maladaptive nature of the reaction is indicated by either of
      the following:
      1. impairment in occupational (including school) functioning or in
         usual social activities or relationships with others
      2. symptoms that are in excess of a normal and expectable reaction
         to the stressor(s)
   C. The disturbance is not merely one instance of a pattern of
      overreaction to stress or an exacerbation of one of the mental
      disorders previously described (in the entire DSM).
   D. The maladaptive reaction has persisted for no longer than six
      months.
   E. The disturbance does not meet criteria for any specific mental
      disorder and does nor represent Uncomplicated Bereavement.


Causes
------

Q. What causes depression?

   The group of symptoms which doctors and therapists use to diagnose
   depression ("depressive symptoms"), which includes the important
   proviso that the symptoms have manifested for more than a few weeks
   and that  they are interfering with normal life, are the result of an
   alteration in brain chemistry. This alteration is similar to
   temporary, normal variations in brain chemistry which can be
   triggered by illness, stress, frustration, or grief, but it differs
   in that it is self-sustaining and does not resolve itself upon
   removal of such triggering events (if any such trigger can be found
   at all, which is not always the case.)

   Instead, the alteration continues, producing depressive symptoms and
   through those symptoms, enormous new stresses on the person:
   unhappiness, sleep disorders, lack of concentration, difficulty in
   doing one's job, inability to care for one's physical and emotional
   needs, strain on existing relationships with friends and family.
   These new stresses may be sufficient to act as triggers for
   continuing brain chemistry alteration, or they may simply prevent the
   resolution of the difficulties which may have triggered the initial
   alteration, or both.

   The depressive brain chemistry alteration seems to be self-limiting
   in most cases: after one to three years, a more normal chemistry
   reappears, even without medical treatment. However, if the alteration
   is profound enough to cause suicidal impulses, a majority of
   untreated depressed people will in fact attempt suicide, and as many
   as 17% will eventually succeed. Therefore, depression must be thought
   of as a potentially fatal illness. Friends and relatives may be
   deceived by the casual way that profoundly depressed people speak of
   suicide or self-mutilation. They are not casual because they "don't
   really mean it"; they are casual because these things seem no worse
   than the mental pain they are already suffering. Any comment such as,
   "You'd be better off if I were gone," or "I wish I could just jump
   out a window," is the equivalent of a sudden high fever; the
   depressed person must be taken to a professional who can monitor
   their danger. A formulated plan, such as, "I'm going to jump in front
   of the next car that comes by," is the equivalent of sudden
   unconsciousness: an immediate medical emergency which may require
   hospitalization.

   Depression can shut down the survival instinct or temporarily
   suppress it. Therefore, depressed suicidal thinking is not the same
   as the suicidal thinking of normal people who have reached a crisis
   point in their lives. Depressive suicides give less warning, need
   less time to plan, and are willing to attempt more painful and
   immediate means, such as jumping out of a moving car. They may also
   fight the impulse to suicide by compromising on self-injury --
   cutting themselves with knives, for example, in an attempt to
   distract themselves from severe mental pain. Again, relatives and
   friends are likely to be astonished by how quickly such an impulse
   can appear and be acted upon.

..


Archive-name: alt-support-depression/faq/part2
Posting-Frequency: bi-weekly
Last-modified: 1994/08/06


Part 2 of 5
===========

  **Causes** (cont.)
   - What initiates the alteration in brain chemistry?
   - Is a tendency to depression inherited?

  **Treatment**
   - What sorts of psychotherapy are effective for depression?

  **Medication**
   - Do certain drugs work best with certain depressive illnesses? What
     are the guidelines for choosing a drug?
   - How do you tell when a treatment is not working? How do you know
     when to switch treatments?
   - How do antidepressants relieve depression?
   - Are Antidepressants just "happy pills?"
   - What percentage of depressed people will respond to
     antidepressants?
   - What does it feel like to respond to an antidepressant? Will I
     feel euphoric if my depression responds to an antidepressant?
   - What are the major categories of anti-depressants?
   - What are the side-effects of some of the commonly used
     antidepressants?
   - What are some techniques that can be used by people taking
     antidepressants to make side effects more tolerable?
   - Many antidepressants seem to have sexual side effects. Can
     anything be done about those side-effects?
   - What should I do if my antidepressant does not work?


Causes (cont.)
--------------

Q. What initiates the alteration in brain chemistry?

   It can be either a psychological or a physical event. On the physical
   side, a hormonal change may provide the initial trigger: some women
   dip into depression briefly each month during their premenstrual
   phase; some find that the hormone balance created by oral
   contraceptives disposes them to depression; pregnancy, the end of
   pregnancy, and menopause have also been cited. Men's hormone levels
   fluctuate as deeply but less obviously.

   It is well known that certain chronic illnesses have depression as a
   frequent consequence: some forms of heart disease, for example, and
   Parkinsonism. This seems to be the result of a chemical effect rather
   than a purely psychological one, since other, equally traumatic and
   serious illnesses don't show the same high risk of depression.


Q. Is a tendency to depression inherited?

   It seems there are some people whose brain chemistry is predisposed
   to the depressive response, and others who are at much lower risk of
   depression even if exposed to the same physical or psychological
   triggers. The genetic relations of manic-depressives are at a higher
   risk for unipolar depression than the population at large or their
   adopted/by marriage relations. There seems to be a link between high
   creativity and the gene for manic-depression: artists and writers
   often are not manic-depressive themselves, but have a family member
   who is. Studies of families in which members of each generation
   develop manic-depressive illness found that those with the illness
   have a somewhat different genetic make-up than those who do not get
   ill. However, the reverse is not true: not everybody with the genetic
   make-up that causes vulnerability to manic-depressive illness has the
   disorder. Apparently additional factors, possibly a stressful
   environment, are involved in its onset.

   Major depression also seems to occur, generation after generation, in
   some families. However, depression can occur in people with no family
   history of any form of mental illness. And I would be reluctant to
   suggest that there is any human who is entirely immune to depression
   under all possible conditions.

   Psychological triggers: many, if not most, people with depression can
   point to some incident or condition which they believe is responsible
   for their unhappiness. Of course, people with severe depression are
   prone to astonishingly virulent and inappropriate guilt and
   self-hatred.

   The (genuine) life events that most often appear in connection with
   depression are various, but there is one distinguishing feature that
   appears in many cases, over and over: loss of self-determination, of
   empowerment, of self-confidence. More profoundly: a loss of self, of
   the abilities or activities that a person identifies with herself.
   Stereotypically: a man loses the job that had defined him to himself
   and others, whether that definition was "executive" or "breadwinner";
   a woman who had spent her whole life preparing for and living the
   role of wife, supporter, caretaker, is suddenly left alone by divorce
   or death. In general, any life change, often caused by events beyond
   one's control, which damages the structure that gave life meaning.

   The ability of a person to respond to such an event will depend on
   many factors, including genetic predisposition, support from friends,
   physical health, even the weather. It can also depend on internal
   psychological factors which may best be explored in talk therapy: why
   is the person's self-esteem so bound up in the position or state that
   has been lost? Can she find a new source of self-esteem? Therapy can
   be immensely helpful here.

   Obviously, not everyone to whom this sort of event happens becomes
   depressed, and not every person who becomes depressed has had this
   sort of catastrophe befall them. In fact, if a person suffers a loss
   and then becomes depressed, it may well be that they weathered the
   loss in fine style and then succumbed to a much less obvious trigger,
   psychological or physical.

   Some depressions may well be caused by a spontaneous aberration in
   brain chemistry, with no trigger that we can currently identify, just
   as a seizure or migraine may have an obvious trigger or be apparently
   spontaneous.

   However, once the depressive state has set in, both physical and
   psychological problems will be generated in abundance. What faster
   way to lose a job or a spouse than to be too depressed to work or to
   communicate? What worse psychological state for coping with a blow to
   identity can there be than a chemically promoted, pathological
   self-hatred? And what can be worse for self-esteem than watching
   one's appearance and household disintegrate as one loses the
   motivation to shower, straighten up, wash dishes or laundry, or
   choose attractive clothes? Health deteriorates as well: some
   depressed people can't sleep or eat, others sleep constantly (a real
   help on the job!) and eat incessantly, sometimes in order to stay
   awake, sometimes because it's the only thing that gives a little
   pleasure or comfort. (Carbohydrates induce production of serotonin,
   so there may be an element of self-medication here); almost no one
   has the impulse to exercise or get fresh air and sunshine. Most if
   not all of these effects form feedback loops, increasing in magnitude
   and becoming triggers for further depression.

   The question, "Is depression mostly physical or psychological," is
   rather beside the point. Depression may be triggered by either
   physical or psychological events. Most commonly, both seem to be
   involved, though it is often difficult to separate the two when one
   is talking about psychology and neurochemistry. But however it
   begins, depression quickly develops into a set of physical and
   psychological problems which feed on each other and grow. This is why
   a combination of physical and psychological intervention has been
   shown to give the best results for most patients, regardless of any
   classifications that doctors may have tried to impose on their
   depression and its cause.


Treatment
---------

Q. What sorts of psychotherapy are effective for depression?

   Two effective methods of psychotherapy for people with depressions
   are cognitive therapy and interpersonal therapy. Both psychoanalysis,
   and insight oriented psychotherapy have not been shown to be
   effective treatments for people with a depressive disorder. Cognitive
   (and cognitive-behavioral) therapists can be found in most major
   cities.

   For a referral to a properly trained cognitive therapist practicing
   close to your location, contact:

      Aaron T. Beck, MD.
      The Center for Cognitive Therapy
      3600 Market Street
      Philadelphia, PA 19101
      [phone].

   While many therapists call themselves cognitive therapists and
   interpersonal therapists, only a few have had proper training. To
   find an interpersonal therapist with the best training, contact:

      Myrna Weissman, Ph.D.
      New Your State Psychiatric Institute
      722 West 168th Street
      New York, NY 10032
      [phone]


Medication
----------

Q. Do certain drugs work best with certain depressive illnesses? What
   are the guidelines for choosing a drug?

   There are very few kinds of depression for which there are specific
   antidepressant treatments. When it comes to people with Bipolar
   Disorder who are depressed there are some major problems. Most
   importantly, with any antidepressant, there is a possibility that the
   antidepressant treatment will cause depressed bipolar people not just
   to come out of their depressions, but to develop manic episodes. The
   possibility of an antidepressant causing mania is least when the
   antidepressant is bupropion (Wellbutrin). The possibility of mania is
   greatly reduced if depressed bipolar folks are on a mood stabilizer
   such as lithium, Tegretol or Depakote when they are started on an
   antidepressant.


Q. How do you tell when a treatment is not working? How do you know when
   to switch treatments?

   Antidepressant treatment is clearly not working when the individual
   receiving the treatment remains depressed or becomes depressed again.
   When a recently started antidepressant fails to cause improvement,
   the depressed individual often asks that the medication be stopped,
   and a new one started. It generally does not make sense to change
   antidepressants until 8-weeks at the maximum tolerated dose have
   elapsed. With some tricyclic antidepressants, it is important to
   check the blood level of the antidepressant before it is stopped. The
   blood test can tell if the amount in the blood has been adequate.
   Only after an adequate trial of one antidepressant should another be
   tried. To have been on four antidepressants in an 8-week period means
   that one has not had an adequate trial on any of them.


Q. How do antidepressants relieve depression?

   There are several classes of antidepressants, all of which seem to
   work by increasing levels of certain neurotransmitters (most commonly
   serotonin, norepinephrine, and dopamine) in the brain. It is not
   entirely clear why increasing neurotransmitter levels should reduce
   the severity of a depression. One theory holds that the increased
   concentration of neurotransmitters causes changes in the brain's
   concentration of molecules, receptors, to which these transmitters
   bind. In some unknown way it is the changes in the receptors that are
   thought responsible for improvement.


Q. Are Antidepressants just "happy pills?"

   No matter what their exact mode of action may be, it is clear that
   antidepressants are not "happy pills." There is no street-market in
   antidepressants, for unlike "speed" which will improve the mood of
   almost everybody, antidepressants only improve the mood of depressed
   people. Also unlike the almost instant effects of speed, the
   mood-improving effects of antidepressants develop slowly over a
   number of weeks. "Speed" induces a highly artificial state,
   antidepressants cause the brain to slowly increase its production of
   naturally occurring neurotransmitters.


Q. What percentage of depressed people will respond to antidepressants?

   Generally, about 2/3 of depressed people will respond to any given
   antidepressant. People who do not respond to the first antidepressant
   they have taken, have an excellent chance of responding to another.


Q. What does it feel like to respond to an antidepressant? Will I feel
   euphoric if my depression responds to an antidepressant?

   The most common description of the effects of antidepressants is that
   of feeling the depression gradually lift, and for the person to feel
   normal again. People who have responded to antidepressants are not
   euphoric. They are not unfeeling automatons. The are still able to
   feel sad when bad things happen, and they are able to feel very happy
   in response to happy events. The sadness they feel with
   disappointments is not depression, but is the sadness anyone feels
   when disappointed or when having experienced a loss. Antidepressants
   do not bring about happiness, they just relieve depression. Happiness
   is not something that can be had from a pill.


Q. What are the major categories of anti-depressants?

   There are many classes of antidepressants. Two kinds of
   antidepressants have been around for over 30 years. These are the
   tricyclic antidepressants and the monoamine oxidase inhibitors. While
   there are newer antidepressants, many with fewer side-effects, none
   of the newer antidepressants has been shown to be more effective than
   these two classes of drugs. In fact, many people who have not
   responded to newer antidepressants have been successfully treated
   with one of these classes of drugs.

   The tricyclic antidepressants (TCAs) include such drugs as imipramine
   (Tofranil, amitriptyline (Elavil), desipramine (Norpramin),
   nortriptyline (Aventyl and Pamelor).

   The monoamine oxidase inhibitors (MAOIs) include tranylcypromine
   (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) which has
   recently been taken off the market in the U.S.A. for marketing rather
   than safety or efficacy reasons.

   One of the popular new classes of antidepressants are the selective
   serotonin reuptake inhibitors (SSRIs). The first of these drugs to be
   marketed in the USA was fluoxetine (Prozac). Sertraline (Zoloft), and
   paroxetine (Paxil) soon followed, and fluvoxamine (Luvox) is
   scheduled to be marketed in late 1994, or early 1995.

   Bupropion (Wellbutrin) is the only drug in its class, as is trazodone
   (Desyrel). The most recently marketed antidepressant (4/94) is
   venlafaxine (Effexor), the first drug in yet another class of drugs.


Q. What are the side-effects of some of the commonly used
   antidepressants?

   Below is a list of some of the more frequently prescribed
   antidepressants, and their most common side effects. The figure
   following each side effect is the percentage of people taking the
   medication who experience that side effect.

   Aventyl (nortriptyline): Dry mouth (15); Constipation (15);
   Weakness-fatigue (10); Tremor (10).

   Effexor (venlafaxine) Nausea (35); Headache (25); Sleepiness (25);
   Dry mouth (20); Insomnia (20); Constipation (15).

   Elavil (amitriptyline): Dry mouth (40); Drowsiness (30); Weight gain
   (30); Constipation (25); Sweating (20).

   Nardil (phenelzine): dry mouth (30); insomnia (25); Increased heart
   rate (25); Lowered blood pressure (20); Sedation (15); Over
   stimulation (10);

   Norpramin (desipramine): dry mouth (15); increased pulse (15);
   constipation (10); reduced blood pressure (10).

   Pamelor - see Aventyl

   Parnate (tranylcypromine) Dry mouth (20); Insomnia (20); Increased
   pulse rate (20); Lowered blood pressure (15); Over stimulation (15);
   Sedation (15).

   Paxil (paroxetine): Decreased sexual interest and/or problems
   achieving orgasm (30); Nausea (25); Sedation (25); Dizziness (15)
   Insomnia (15)

   Prozac (fluoxetine): Decreased sexual interest and/or problems
   achieving orgasm (30); Nausea (20); Headache (20); Nervousness (15);
   Insomnia (15); Diarrhea (15).

   Sinequan (doxepin): Dry mouth (40); Sedation (40); Weight gain (30);
   Lowered blood pressure (25); Constipation (25); Sweating (20).

   Tofranil (imipramine): Dry mouth (30), Reduced blood pressure (30),
   Constipation (20), Difficulty with urination (15).

   Wellbutrin (bupropion): Agitation (30); Weight loss (25), Dizziness
   (20); Decreased appetite (20);

   Zoloft (sertraline): Decreased sexual interest and/or problems
   achieving orgasm (30);Nausea (25); Headache (20); Diarrhea (20);
   Insomnia 15); Dry mouth (15); Sedation (15).


Q. What are some techniques that can be used by people taking
   antidepressants to make side effects more tolerable?

   Listed below are some frequent side effects of antidepressants, and
   some techniques to reduce their severity:

   Dry mouth: Drink lots of water, chew sugarless gum, clean teeth
   daily, ask the dentist to suggest a fluoride rinse to prevent
   cavities, visit the dentist more often than usual for tooth and gum
   hygiene

   Constipation: Drink at least six 8-ounce glasses of water every day,
   eat bran cereals, eat salads twice a day, exercise daily (walk for at
   least 30 minutes a day), ask your doctor about taking a bulk
   producing agent such as Metamucil, also ask about taking a stool
   softener such as Colace, be sure to avoid laxatives such as Ex-Lax.

   Bladder problems: The effects of some antidepressants, especially the
   tricyclic medications may make it difficult for you to start the
   stream of urine. There may be some hesitation between the time you
   try to urinate and the time your urine starts to flow. If it takes
   you over 5-minutes to start the stream, call your doctor.

   Blurred vision: The tricyclic antidepressants may make it difficult
   for you to read. Distant vision is usually unaffected. If reading is
   important to you the effects of the antidepressant can be compensated
   for by a change in glasses. As you may compensate for the change in
   your vision, try to postpone getting new glasses as long as possible.

   Dizziness: Dizziness when getting out of bed or when standing up from
   a chair, or when climbing stairs may be a problem when taking
   tricyclic antidepressants and monoamine oxidase inhibitors. Changing
   posture slowly may help prevent this kind of dizziness. Drinking
   adequate amounts of liquid and eating enough salt each day is
   important. Be sure to speak to your doctor if this side-effect is
   severe.

   Drowsiness: This side effect often passes as you get used to taking
   the antidepressant that has been prescribed for you. Ask your doctor
   if it is safe for you to increase your intake of caffeine, and if so,
   by how much. If you are drowsy be sure not to drive or operate
   dangerous machinery.


Q. Many antidepressants seem to have sexual side effects. Can anything
   be done about those side-effects?

   Both lowered sexual desire and difficulties having an orgasm, in both
   men and women, are particularly a problem with the selective
   serotonin re-uptake inhibitors (Prozac, Zoloft, Paxil and Luvox), and
   the monoamine oxidase inhibitors (Nardil and Parnate). There is no
   treatment for decreased sexual interest except lowering the dose or
   switching to a drug that does not have sexual side effects such as
   bupropion (Wellbutrin). Difficulty having orgasms may be treated by a
   number of medications. Among those medications are: Periactin,
   Urecholine, and Symmetrel. None of these are over-the-counter drugs
   and they must be prescribed by a physician. Unfortunately, many
   psychiatrists are not familiar with using these medications to treat
   the sexual side-effects of antidepressants.


Q. What should I do if my antidepressant does not work?

   Many people decide that their antidepressant is not working
   prematurely. When one starts an antidepressant the hope is for rapid
   relief from depression. What must be remembered is that for an
   antidepressant to work, you must be on an adequate dose of the drug
   for an adequate length of time. A fair trial of any antidepressant is
   at least two months. Prior to a two month trial the only reason to
   abandon an antidepressant trial is if the medication is causing
   severe side effects. With many antidepressants the dose has to be
   increased at intervals far above the starting dose. Unfortunately,
   the two-month period mentioned above, refers to two months following
   the most recent increase in the dose, not the time from starting the
   particular antidepressant.

..


Archive-name: alt-support-depression/faq/part3
Posting-Frequency: bi-weekly
Last-modified: 1994/08/07


Part 3 of 5
===========

  **Medication** (cont.)
   - If an antidepressant has produced a partial response, but has not
     fully eliminated depression, what can be done about it?

  **Electroconvulsive Therapy**
   - What is electroconvulsive therapy (ECT) and when is it used?
   - Exactly what happens when someone gets ECT?
   - How do individuals who have had ECT feel about having had the
     treatments?
   - How long do the beneficial effects of ECT last?
   - Is it true that ECT causes brain damage?
   - Why is there so much controversy about ECT?

  **Substance Abuse**
   - May I drink alcohol while taking antidepressants?
   - If I plan to drink alcohol while on medication, what precautions
     should I take?
   - What's the relationship between depression and recovery from
     substance abuse?
   - What does the term "dual-diagnosis" mean?
   - Is it safe for a person recovering from substance abuse to take
     drugs?
   - How do you know when depression is severe enough that help should be
     sought?

  **Getting Help**
   -Where should a person go for help?
   -Where can I find help in the United Kingdom?
   -Where can I find out about support groups for depression?
   -How can family and friends help the depressed person?

  **Choosing A Doctor**
   -What should you look for in a doctor? How can you tell if he/she really
    understands depression?

  **Self-care**
   - How may I measure the effects my treatment is having on my
     depression?


Medication (cont.)
------------------

Q. If an antidepressant has produced a partial response, but has not
   fully eliminated depression, what can be done about it?

   There are many techniques to help an antidepressant work more
   completely. The simplest is to increase the dose until relief is
   experienced or side- effects are severe. If the dose can not be
   increased, lithium can be added to any antidepressant to augment its
   effect. With all antidepressants it is possible to add small doses of
   stimulants such as pemoline (Cylert), methylphenidate (Ritalin), or
   dextroamphetamine (Dexedrine) to augment the antidepressant effect.
   Selective serotonin re-uptake inhibitors often work better when small
   doses of desipramine (Norpramin) or nortriptyline (Aventyl and
   Pamelor) are co-administered. Thyroid hormones (Synthroid or Cytomel)
   may be used to augment any antidepressant. At times combinations of
   these techniques may be utilized.


Electroconvulsive Therapy
-------------------------

Q. What is electroconvulsive therapy (ECT) and when is it used?;

   ECT is an effective form of treatment for people with depressions and
   other mood disorders. ECT may be used when a severely depressed
   patient has not responded to antidepressants, is unable to tolerate
   the side effects of antidepressants, or must improve rapidly. Some
   depressed people simply do not respond to antidepressants or mood
   controlling drugs, and ECT is a way for such people to be effectively
   treated. ECT is utilized in the treatment of both mania and
   depression. There are some people who because of severe physical
   illness are unable to tolerate the side-effects of the medications
   used to treat mood disorders. Many of these people can be
   successfully be treated with ECT. Pregnant women and people who have
   recently had heart attacks can be safely treated with ECT. Because of
   time pressure regarding occupational, social, or family events, some
   people do not have the time to wait for antidepressants or mood
   regulating medications to become effective. As ECT quite regularly
   brings about improvement within two or three weeks, people who are
   under such time pressure are also excellent candidates for ECT.


Q. Exactly what happens when someone gets ECT?

   The physician must fully explain the benefits and dangers of ECT, and
   the patient give consent, before ECT can be administered. The patient
   should be encouraged to ask questions about the procedure and should
   be told that consent for treatments can be withdrawn at any time, and
   in the event that this happens, the treatments will be stopped. After
   giving consent, the patient undergoes a complete physical
   examination, including a chest x-ray, electrocardiogram, and blood
   and urine tests. A series of ECTs usually consists of six to twelve
   treatments. Treatments can be administered to either in-patients or
   out-patients. Nothing should be taken by mouth for 8-hours prior to a
   treatment. An intravenous drip is started and through it medications
   to induce sleep, relax the muscles of the body, and reduce saliva are
   given. Once these medications are fully effective, an electrical
   stimulus is administered through electrodes to the head. The
   electrical stimulus produces brain wave (EEG) changes that are
   characteristic of a grand mal seizure. It is believed that this
   seizure activity leads to the clinical improvement seen after a
   series of ECT. About 30-minutes after the treatment the patient
   awakens from sleep. While confused at first, the patient is soon
   oriented enough to eat breakfast, and return home if the treatments
   are being done in an outpatient setting.


Q. How do individuals who have had ECT feel about having had the
   treatments?

   In studies of people treated with ECT it has been found that 80% of
   such people report that they were helped by the treatments. About 75%
   say that ECT is no more frightening than going to the dentist.


Q. How long do the beneficial effects of ECT last?;

   While ECT is a highly successful way of helping people come out of
   depressions, it has to be followed by antidepressant therapy. If
   antidepressants are not administered after a series of ECTs, there is
   a 50% relapse rate within 6-months.

Q. Is it true that ECT causes brain damage?;

   There is no scientific evidence that ECT causes brain damage. A woman
   who had over 1,000 ECT died of natural causes, and her brain was
   examined for evidence of ECT-induced brain damage. None was found.
   ECT does cause memory problems. These memory problems may take a
   number of months to clear. A small number of people who have received
   ECT complain of longer lasting memory problems. Such problems do not
   show up on psychological tests, it is not clear what causes them.

Q. Why is there so much controversy about ECT?

   There is little controversy about ECT among psychiatrists. Much of
   the opposition to ECT seems political in nature and originates in the
   anti-psychiatry groups that oppose the use of Ritalin for the
   treatment of children with attention deficit disorder, and who oppose
   the use of Prozac for the treatment of depressed people.


Substance Abuse
---------------

Q. May I drink alcohol while taking antidepressants?

   There are a number of problems with the mixture of alcohol and
   antidepressants. First, antidepressants may make you especially
   susceptible to the intoxicating effects of alcohol. Second, if you
   drink more than three or four drinks a week, the effects of alcohol
   may prevent the antidepressants from working. Many people who seem
   not to benefit from antidepressants, do so, if they reduce or
   eliminate their intake of alcohol. Third, you may be taking along
   with the antidepressant a drug such as clonazepan (Klonopin) with
   which one should not drink at all.


Q. If I plan to drink alcohol while on medication, what precautions
   should I take?

   There is much misinformation about drinking while on anti-
   depressants. Alcohol can prevent antidepressants from being
   effective. This is not so much because it interferes with the
   absorption of antidepressants, it is because of the effects of
   alcohol upon brain chemistry. Antidepressants can also increase one's
   susceptibility to the intoxicating effects of alcohol. Also, both
   alcohol and some anti- depressants (especially Wellbutrin) increase
   the possibility of seizures.

   If you are determined to drink despite taking antidepressants you
   should discuss the matter with your psychiatrist. If you get
   permission you might want to determine the extent to which the
   medication has made you more sensitive to the alcohol. You might
   start by seeing what are the effects of half a glass of wine. You
   might then experiment with a full glass. Remember, a 4 oz glass of
   wine, a 12 oz bottle of beer, and 1 oz of "hard stuff" all contain
   the same amount of alcohol.


Q. What's the relationship between depression and recovery from
   substance abuse?

   It is not unusual for people who have recently been withdrawn from
   alcohol, or other abusable drugs to become depressed. These
   depressions are often self-limited, and clear in about 8-weeks. If
   depression has not cleared by the end of that period, anti-depressant
   therapy should be started.


Q. What does the term "dual-diagnosis" mean?

   Dual-diagnosis is a phrase used to indicate the combination of
   substance abuse and a psychiatric disorder. A path to alcohol or
   other substance abuse is an attempt to self- medicate uncomfortable
   symptoms such as depression, anxiety, agitation or feelings of
   emptiness. The psychiatric disorders that cause such symptoms are
   often diagnosed in substance abusers.


Q. Is it safe for a person recovering from substance abuse to take
   drugs?

   People recovering from substance abuse can safely take many kinds of
   psychiatric drugs. Most psychiatric drugs are unable to be abused.
   The best evidence for this is that there are not street markets for
   such drugs. On the other hand, The benzodiazepines (diazepam
   [Valium], lorazepam [Ativan], alprazolam [Xanax], etc.) and the
   psycho-stimulants (dextroamphetamine [Dexedrine], methamphetamine
   [Desoxyn], and Ritalin [methylphenidate]) are quite abusable.

   For people active in AA please read the pamphlet "The AA
   Member--Medications & Other Drugs." This outlines AA's official
   attitude toward medication--that it is necessary for certain
   illnesses including depression. Too many depressed people who have
   been talked out of taking antidepressants by members of their AA
   groups have killed themselves as a result.


Q. How do you know when depression is severe enough that help should be
   sought?

   Professional help is needed when symptoms of depression arise without
   a clear precipitating cause, when emotional reactions are out of
   proportion to life events, and especially when symptoms interfere
   with day-to-day functioning.. Professional help should definitely be
   sought if a person is experiencing suicidal thoughts.


Getting Help
------------

Q. Where should a person go for help?

   If you think you might need help, see your internist or general
   practitioner and explain your situation. Sometimes an actual physical
   illness can cause depression-like symptoms so that is why it is best
   to see your regular physician first to be checked out. Your doctor
   should be able to refer you to a psychiatrist if the severity of your
   depression warrants it.

   Other sources of help include the members of the clergy, local
   suicide hotline, local hospital emergency room, local mental health
   center.


Q. Where can I find help in the United Kingdom?

   The following are places one might find help in Great Britain:

      Depressives Associated
      PO Box 1022
      London SE1 7QB

      Depressives Anonymous
      36 Chestnut Avenue
      Beverley
      Humberside
      HU17 9QU

      MIND (National association for mental health)
      22 Harley Street
      London W1N 2ED

   To find a psychiatrist/ psychologist near you, call or write:
      Royal College of Psychiatrists
      17 Belgrave Square
      London SW1X 8PG

Q. Where can I find out about support groups for depression?

   The following is a list of national organizations dealing with the
   issues of depression. Please note: Model groups are not national
   organizations and should be contacted primarily by persons wishing to
   start a similar group in their area. Also, please enclose a
   self-addressed stamped envelope when requesting information from any
   group. When calling a contact number, remember that many of them are
   home numbers, so be considerate of the time you call. Keep in mind
   the different time zones.

   [Reprinted from The Self-Help Sourcebook, 4th Edition, 1992. American
   Self-Help Clearinghouse, St.Clares' Riverside Medical Center,
   Denville, New Jersey 07834]

   **Depressed Anonymous** Int'l. 8 affiliated groups. Founded 1985.
   12-step program to help depressed persons believe & hope they can
   feel better. Newsletter, phone support, information & referrals, pen
   pals, workshops, conference & seminars. Information packet ($5),
   group starting manual ($10.95).Newsletter. Write: 1013 Wagner Ave.,
   Louisville, KY 40217. Call Hugh S. 502-969-3359.

   **Depression After Deliver** National. 85 chapters. Founded 1985.
   Support & Information for women who have suffered from post-partum
   depression. Telephone support in most states, newsletter, group
   development guidelines, pen pals, conferences. Write: PO. Box 1281,
   Morrisville, PA 19067. Call 215-295-3994 or 800-944-4773 (to leave
   name & address for information to be sent).

   **Emotions Anonymous** National. 1200 chapters. Founded 1971.
   Fellowship sharing experiences, hopes & strengths with each other,
   using the 12-step program to gain better emotional health.
   Correspondence program for those who cannot attend meetings. Chapter
   development guidelines. Write: PO. Box 4245, St. Paul, MN 55104. Call
   612-647-9712.

   **National Depressive & Manic-Depressive Association**  National. 250
   chapters. Founded 1986. Mutual support & information for
   manic-depressives, depressives & their families. Public education on
   the biochemical nature of depressive illnesses. Annual conferences,
   chapter development guidelines. Newsletter. Write: NDMDA, 730
   Franklin, 501, Chicago, IL 60610. Call 800-82-NDMDA or 312-642-0049.

   **National Foundation for Depressive Illness**. An informational
   service, which provides a recorded message of the clear warning signs
   of depression and manic-depression, and instructs how to get help and
   further information. Call 1-800-239-1295. For a bibliography and
   referral list of physicians and support groups in your area, send $5
   (if you can afford it) and a self-addressed, stamped business-size
   envelope with 98 cents postage to, NAAFDI, PO. Box 2257, New York, NY
   100116.

   NOSAD (**National Organization for Seasonal Affective Disorder**)
   National. groups. Founded 1988. Provides information & education re:
   the causes, nature & treatment of Seasonal Affective Disorder.
   Encourages development of services to patients & families, research
   into causes & treatment. Newsletter. Write: PO. Box 451, Vienna, VA
   22180. Call 301-762-0768.

   (Model) **Helping Hands** Founded 1985. A comfortable & homey
   atmosphere for people with manic-depression, schizophrenia or clinical
   depression who seek an environment that makes them more aware of
   themselves & eliminates a negative attitude. Group development
   guidelines. Write: c/o Rita Martone, 86 Poor St, Andover, MA 01810.
   Call 508-475-3388.

   (Model) MDSG-NY (**Mood Disorders Support Group, Inc.**) Founded
   1981. Support & education for people with manic-depression or
   depression & their families & friends. Guest lectures, newsletter, rap
   groups, assistance in starting groups. Write: PO. Box 1747, Madison
   Square Station, New York, NY 10159. Call 212-533-MDSG.


Q. How can family and friends help the depressed person?

   The most important things anyone can do for depressed people is to
   help them get appropriate diagnosis and treatment. This may involve
   encouraging a depressed individual to stay with treatment until
   symptoms begin to abate (several weeks) or to seek different
   treatment if no improvement occurs. On occasion, it may require
   making an appointment and accompanying the depressed person to the
   doctor. It may also mean monitoring whether the depressed person is
   taking medication.

   The second most important thing is to offer emotional support. This
   involves understanding, patience, affection, and encouragement.
   Engage the depressed person in conversation and listen carefully. Do
   not disparage feelings expressed, but point out realities and offer
   hope. Do not ignore remarks about suicide. Always report them to the
   doctor. Invite the depressed person for walks, outings, to the
   movies, and other activities. Be gently insistent if your invitation
   is refused. Encourage participation in some activities that once gave
   pleasure, such as hobbies, sports, religious or cultural activities,
   but do not push the depressed person to undertake too much too soon.

   The depressed person needs diversion and company. but too many
   demands can increase feelings of failure. Do not accuse the depressed
   person of faking illness or laziness or expect him or her to "snap
   out of it." Eventually, with treatment, most depressed people do yet
   better. Keep that in mind, and keep reassuring the depressed person
   that with time and help, he or she will feel better.


Choosing A Doctor
-----------------

Q. What should you look for in a doctor? How can you tell if he/she
   really understands depression?

   If you are looking for a psychopharmacologist to prescribe
   medications to help control your depression there are a number of
   things to check. If you are in psychotherapy, it is important to ask
   prospective doctors about their opinions on the psychotherapeutic
   treatment of depression. Psychopharmacologists who are hostile to
   psychotherapy are difficult to deal with while you are in therapy.

   It is always legitimate to ask any professionals you are thinking
   about seeing regularly about their understanding of depression, their
   beliefs about the causes of depression and their philosophy of
   treatment. You might ask about how often the prospective doctor has
   worked with people who have had your particular variety of
   depression. If you have a rapidly cycling Bipolar depression, for
   example, you should seek a doctor who has much experience dealing
   with people who have this problem. Prior to the first visit it is
   important to clarify with the doctor or the secretary the fee of the
   initial and subsequent visits, the doctor's policy regarding
   missed and changed appointments, whether the doctor will accept
   assignment from insurance companies. If you have Medicare or
   Medicaid it is important to make sure that the doctor sees people
   with these forms of medical coverage.

   Another aspect of the style of doctors is the extent to which they
   include their patients in the decision-making process. You might ask
   "How do you go about deciding which treatment is right for me?" See
   if you are comfortable with the method the doctor describes. Much can
   also be learned from how doctors respond to questions such as these.
   There is much difference between a doctor who welcomes such questions
   and answers them fully and one who is annoyed by them and answers
   them superficially.


Self-care
---------

Q. How may I measure the effects my treatment is having on my depression?

   If one completes the following scale each week, and keeps track of the
   scores, one would have a detailed record of one's progress.

Name  _________________________                           Date  _________

The items below refer to how you have felt and behaved **during the past
week.** For each item, indicate the extent to which it is true, by
circling one of the numbers that follows it. Use the following scale:

     0 = Not at all
     1 = Just a little
     2 = Somewhat
     3 = Moderately
     4 = Quite a lot
     5 = Very much
_______________________

 1.  I do things slowly............................0   1   2   3   4   5

 2.  My future seems hopeless......................0   1   2   3   4   5

 3.  It is hard for me to concentrate on reading...0   1   2   3   4   5

 4.  The pleasure and joy has gone out of my life..0   1   2   3   4   5

 5.  I have difficulty making decisions............0   1   2   3   4   5

 6.  I have lost interest in aspects of life that
      used to be important to me...................0   1   2   3   4   5

 7.  I feel sad, blue, and unhappy.................0   1   2   3   4   5

 8.  I am agitated and keep moving around..........0   1   2   3   4   5

 9.  I feel fatigued...............................0   1   2   3   4   5

10.  It takes great effort for me to do simple
      things.......................................0   1   2   3   4   5

11.  I feel that I am a guilty person who
      deserves to be punished......................0   1   2   3   4   5

12.  I feel like a failure.........................0   1   2   3   4   5

13.  I feel lifeless--more dead than alive.........0   1   2   3   4   5

14.  My sleep has been disturbed:
      too little, too much, or broken sleep........0   1   2   3   4   5

15.  I spend time thinking about HOW I might
      kill myself..................................0   1   2   3   4   5

16.  I feel trapped or caught......................0   1   2   3   4   5

17.  I feel depressed even when good things
      happen to me.................................0   1   2   3   4   5

18.  Without trying to diet, I have lost,
      or gained, weight............................0   1   2   3   4   5


Note: This scale is designed to measure changes in the severity of
      depression and it has been shown to be sensitive to the changes
      that result from psychotherapeutic or psychopharmacologic
      treatment. These scales are not designed to diagnose the presence
      or absence of either depression or mania.

      Copyright (c) 1993  Ivan Goldberg

..


Archive-name: alt-support-depression/faq/part4
Posting-Frequency: bi-weekly
Last-modified: 1994/08/07


Part 4 of 5
===========

  **Self-care** (cont.)
   - How can I help myself get through depression on a day-to-day basis?

  **Books**
   - What are some books about depression?


Self-care (cont.)
-----------------

Q. How can I help myself get through depression on a day-to-day basis?

   On a day-to-day basis, separate from, or concurrently with therapy or
   medication, we all have our own methods for getting through the worst
   times as best we can. The following comments and ideas on what to do
   during depression were solicited from people in the
   alt.support.depression newsgroup. Sometimes these things work,
   sometimes they don't. Just keep trying them until you find some
   techniques that work for you.

   * Write. Keep a journal. Somehow writing everything down helps keep
     the misery from running around in circles.

   * Listen to your favorite "help" songs (a bunch of songs that have
     strong positive meaning for you)

   * Read (anything and everything) Go to the library and check out
     fiction you've wanted to read for a long time; books about
     depression, spirituality, morality; biographies about people who
     suffered from depression but still did well with their lives
     (Winston Churchill and Martin Luther, to name two;).

   * Sleep for a while

   * Even when busy, remember to sleep. Notice if what you do before
     sleeping changes how you sleep.

   * If you might be a danger to yourself, don't be alone. Find people.
     If that is not practical, call them up on the phone. If there is no
     one you feel you can call, suicide hotlines can be helpful, even if
     you're not quite that badly off yet.

   * Hug someone or have someone hug you.

   * Remember to eat. Notice if eating certain things (e.g. sugar or
     coffee) changes how you feel.

   * Make yourself a fancy dinner, maybe invite someone over.

   * Take a bath or a perfumed bubble bath.

   * Mess around on the computer.

   * Rent comedy videos.

   * Go for a long walk

   * Dancing. Alone in my house or out with a friend.

   * Eat well. Try to alternate foods you like ( Maybe junk foods) with
     the stuff you know you should be eating.

   * Spend some time playing with a child

   * Buy yourself a gift

   * Phone a friend

   * Read the newspaper comics page

   * Do something unexpectedly nice for someone

   * Do something unexpectedly nice for yourself.

   * Go outside and look at the sky.

   * Get some exercise while you're out, but don't take it too seriously.

   * Pulling weeds is nice, and so is digging in the dirt.

   * Sing. If you are worried about responses from critical neighbors,
     go for a drive and sing as loud as you want in the car. There's
     something about the physical act of singing old favorites that's
     very soothing. Maybe the rhythmic breathing that singing enforces
     does something for you too. Lullabies are especially good.

   * Pick a small easy task, like sweeping the floor, and do it.

   * If you can meditate, it's really helpful. But when you're really
     down you may not be able to meditate. Your ability to meditate will
     return when the depression lifts. If you are unable to meditate,
     find some comforting reading and read it out loud.

   * Feed yourself nourishing food.

   * Bring in some flowers and look at them.

   * Exercise, Sports. It is amazing how well some people can play
     sports even when feeling very miserable.

   * Pick some action that is so small and specific you know you can do
     it in the present. This helps you feel better because you actually
     accomplish something, instead of getting caught up in abstract
     worries and huge ideas for change. For example say "hi" to someone
     new if you are trying to be more sociable. Or, clean up one side of
     a room if you are trying to regain control over your home.

   * If you're anxious about something you're avoiding, try to get some
     support to face it.

   * Getting Up. Many depressions are characterized by guilt, and lots
     of it. Many of the things that depressed people want to do because
     of their depressions (staying in bed, not going out) wind up making
     the depression worse because they end up causing depressed people
     to feel like they are screwing things up more and more. So if
     you've had six or seven hours of sleep, try to make yourself get
     out of bed the moment you wake up...you may not always succeed,
     but when you do, it's nice to have gotten a head start on the day.

   * Cleaning the house. This worked for some people me in a big way.
     When depressions are at their worst, you may find yourself unable
     to do brain work, but you probably can do body things. One
     depressed person wrote, "So I spent two weeks cleaning my house,
     and I mean CLEANING: cupboards scrubbed, walls washed, stuff given
     away... throughout the two weeks, I kept on thinking "I'm not
     cleaning it right, this looks terrible, I don't even know how to
     clean properly", but at the end, I had this sparkling beautiful
     house!"

   * Volunteer work. Doing volunteer work on a regular basis seems to
     keep the demons at bay, somewhat... it can help take the focus off
     of yourself and put it on people who may have larger problems (even
     though it doesn't always feel that way).

   * In general, It is extremely important to try to understand if
     something you can't seem to accomplish is something you simply CAN'T
     do because you're depressed (write a computer program, be charming
     on a date), or whether its something you CAN do, but it's going to
     be hell (cleaning the house, going for a walk with a friend, getting
     out of bed). If it turns out to be something you can do, but don't
     want to, try to do it anyway. You will not always succeed, but try.
     And when you succeed, it will always amaze you to look back on it
     afterwards and say "I felt like such shit, but look how well I
     managed to...!" This last technique, by the way, usually works for
     body stuff only (cleaning, cooking, etc.). The brain stuff often
     winds up getting put off until after the depression lifts.

   * Do not set yourself difficult goals or take on a great deal of
     responsibility.

   * Break large tasks into many smaller ones, set some priorities, and
     do what you can, as you can.

   * Do not expect too much from yourself. Unrealistic expectations will
     only increase feelings of failure, as they are impossible to meet.
     Perfectionism leads to increased depression.

   * Try to be with other people, it is usually better than being alone.

   * Participate in activities that may make you feel better. You might
     try mild exercise, going to a movie, a ball game, or participating
     in religious or social activities. Don't overdo it or get upset if
     your mood does not greatly improve right away. Feeling better takes
     time.

   * Do not make any major life decisions, such as quitting your job or
     getting married or separated while depressed. The negative thinking
     that accompanies depression may lead to horribly wrong decisions.
     If pressured to make such a decision, explain that you will make the
      decision as soon as possible after the depression lifts. Remember
     you are not seeing yourself, the world, or the future in an objective
     way when you are depressed.

   * While people may tell you to "snap out" of your depression, that is
     not possible. The recovery from depression usually requires
     antidepressant therapy and/or psychotherapy. You cannot simple make
      yourself "snap out" of the depression. Asking you to "snap out" of a
      depression makes as much sense as asking someone to "snap out" of
     diabetes or an under-active thyroid gland.

   * Remember: Depression makes you have negative thoughts about
     yourself, about the world, the people in your life, and about the
     future. Remember that your negative thoughts are not a rational way
     to think of things. It is as if you are seeing yourself, the world,
     and the future through a fog of negativity. Do not accept your
     negative thinking as being true. It is part of the depression and
     will disappear as your depression responds to treatment. If your
     negative (hopeless) view of the future leads you to seriously
     consider suicide, be sure to tell your doctor about this and ask for
     help. Suicide would be an irreversible act based on your
     unrealistically hopeless thoughts.

   * Remember that the feeling that nothing can make depression better
     is part of the illness of depression. Things are probably not
     nearly as hopeless as you think they are.

   * If you are on medication:
     a. Take the medication as directed. Keep taking it as directed
        for as long as directed.
     b. Discuss with the doctor ahead of time what happens in case of
        unacceptable side-effects.
     c. Don't stop taking medication or change dosage without discussing
        it with your doctor, unless you discussed it ahead of time.
     d. Remember to check about mixing other things with medication. Ask
        the prescribing doctor, and/or the pharmacist and/or look it up
        in the Physician's Desk Reference. Redundancy is good.
     e. Except in emergencies, it is a good idea to check what your
        insurance covers before receiving treatment.

   * Do not rely on your doctor or therapist to know everything. Do some
     reading yourself. Some of what is available to read yourself may be
     wrong, but much of it will shed light on your disorder.

   * Talk to your doctor if you think your medication is giving
     undesirable side-effects.

   * Do ask them if you think an alternative treatment might be more
     appropriate for you.

   * Do tell them anything you think it is important to know.

   * Do feel free to seek out a second opinion from a different
     qualified medical professional if you feel that you cannot get what you
     need from the one you have.

   * Skipping appointments, because you are "too sick to go to the
     doctor" is generally a bad idea..

   * If you procrastinate, don't try to get everything done. Start by
     getting one thing done. Then get the next thing done. Handle one
     crisis at a time.

   * If you are trying to remember too many things to do, it is okay to
     write them down. If you make lists of tasks, work on only one task
     at a time. Trying to do too many things can be too much. It can be
     helpful to have a short list of things to do "now" and a longer
     list of things you have decided not to worry about just yet. When you
     finish writing the long list, try to forget about it for a while.

   * If you have a list of things to do, also keep a list of what you
     have accomplished too, and congratulate yourself each time you get
     something done. Don't take completed tasks off your to-do list. If
     you do, you will only have a list of uncompleted tasks. It's useful
     to have the crossed-off items visible so you can see what you have
     accomplished

   * In general, drinking alcohol makes depression worse. Many cold
     remedies contain alcohol. Read the label. Being on medication may
     change how alcohol affects you.

   * Books on the topic of "What to do during Depression": "A Reason to
     Live," Melody Beattie, Tyndale House Publishers, Wheaton, IL. 167
     pages. This book focuses on reasons to choose life over suicide,
     but is still useful even if suicide isn't on your mind. In fact, it
     reads a lot like this portion of the FAQ. An excerpt:

   * Do two things each  day. In times of severe crisis, when you don't
     want to do anything, do two things each day. Depending on your physical
      and emotional condition, the two things could be taking a shower and
      making a phone call, or writing a letter and painting a room.

   * Get a cat. Cats are clean and quiet, they are often permitted by
     landlords who won't allow dogs, they are warm and furry.


Books
-----

Q. What are some books about depression?

   This is an shorter version from a list of books compiled from the
   personal recommendations of the members/readers/participants of the
   Walkers-in-Darkness mailing list, the alt.support.depression
   newsgroup, and the Mood Disorders Support Network on AOL.

   The full list is available at the Walkers ftp site (see Internet
   Resources) and at the MIT *.answers site, rtfm.mit.edu;
   pub/usenet/alt-support-depression/books

   If you have any additions, updates, corrections, etc. for this list,
   please send email to "[e-mail]" (Dan Ash).

   ~A Brilliant Madness: Living with Manic Depressive Illness.~ Patty
   "Anna" Duke and Gloria Hochman. Bantam Books 1992 Comments: Patty
   Duke's very personal account of her account of her struggle with
   manic-depression.

   ~The Broken Brain: The Biological Revolution in Psychiatry.~ Nancy
   Andreasen, MD, Ph.D.. Harper. Perennial. 1984

   ~Care of the Soul.~ Thomas Moore. Harper. Perennial. 1992

   ~The Consumers Guide to Psychotherapy.~ Jack Engler, Ph.D. and Daniel
   Goleman, Ph.D. Fireside-Simon & Schuster. 1992

   ~Cognitive Therapy & The Emotional Disorders.~ Aaron T. Beck, MD
   Penguin. Meridian. 1976

   ~Darkness Visible: A Memoir of Madness.~ William Styron. Vintage. 1990.

   ~The Depression Handbook.~ Workbook. Mary Ellen Copeland

   ~Depression and it's Treatment.~ John H. Greist, MD.. and James W.
   Jefferson, MD.. Warner Books. 1992

   ~The Essential Guide to Psychiatric Drugs.~ Jack Gorman. St. Martin's
   Press. 1992

   ~Everything You Wanted to Know About Prozac.~ Jeffrey M. Jonas, MD and
   Ron Schaumburg. Bantam. 1991

   ~Feeling Good: The New Mood Therapy.~ David Burns, MD. Signet. 1980
   Self-help cognitive therapy techniques for depression, anxiety, etc.

   ~The Feeling Good Handbook.~ David D. Burns, MD. Plume. 1989

   ~Good Mood: The New Psychology of Overcoming Depression.~ Julian L.
   Simon. Open Court Press. 1993.

   ~The Good News About Depression.~ Mark S. Gold. Bantam. 1986

   ~Listening To Prozac.~ Peter D. Kramer, M.D. Viking. 1993 A
   psychiatrist explores some of the implications of anti- depressants,
   and especially of Prozac's unusual effects on the personality. Kramer
   also discusses the recent research on depression, as well as several
   other issues which seem linked to depression.

   ~How to Heal Depression.~ Harold H. Bloomfield, MD and Peter
   McWilliams. Prelude Press. 1994

   ~Manic-Depressive Illness.~ Fredrick K. Goodwin, MD, & Kay Redfield
   Jamison, Ph.D.. Oxford. 1990

   ~Munchausen's Pigtail.~ Psychotherapy and 'Reality': Essays & Lectures.
   Paul Walzlawick, Ph.D.. Norton

   ~On The Edge Of Darkness.~ Kathy Cronkite. Doubleday. 1994

   ~Overcoming Depression.~ Demitri F. and Janice Papolos. Harper.
   Perennial. 1992. Good basic text on the various aspects of depression
   and manic depression. Considered by some to be a "classic" in the
   field.

   ~A Primer of Drug Action: A Concise, Non technical Guide to the"
   "Actions,Uses and Side Effects of Psychoactive Drugs.~ Robert M.
   Julien. W.H. Freeman. 1992. 6 ed.

   ~Prozac: Questions and Answers for Patients, Families and Physicians.~
   Dr. Robert Fieve, MD... Avon. 1993

   ~Questions and Answers about Depression and its Treatment.~ Dr. Ivan
   Goldberg. The Charles Press in Philadelphia. 1993. A 112-page FAQ on
   depression that has appeared in book form. Dr. Goldberg has also
   contributed to the FAQ for a.s.d. and frequently posts to
   Walkers-in-darkness.

   ~A Reason to Live.~ Melody Beattie (General Editor).. Tyndale House
   Publishers, Inc.. 1992. This is a book that explores reasons to live
   and reasons not to commit suicide. It also contains suggestions for
  life-affirming actions people can take to help themselves get through
  those times when they're struggling to find a reason to live.

   ~From Sad to Glad.~ Nathan S. Kline, MD. Ballantine Books.. 1991 20th
   printing. Out of date pharmacologically "but excellent otherwise."
   Kline says: "Psychiatry has labored too long under the delusion that
   every emotional malfunction requires an endless talking out of
   everything the patient ever experienced."

   ~Season of the Mind.~ Norman Rosenthal, MD.. This book explores
   Seasonal Affective Disorder.

   ~Talking Back to Prozac.~ Peter Breggin. St. Martins Press. 1994

   ~Touched with Fire: Manic-depressive Illness and the Artistic~
   ~Temperament.~ Kay Jamison. A look at a number of 19th century poets,
   writers, and composers who were Bipolar. This book in quoted
   liberally in this FAQ under "Who are some famous people with
   depression?"

   ~Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace Drugs,~
   ~Electroshock, and the Biochemical Theories of the 'New Psychiatry'.~
   Peter Breggin. St. Martin's Press. 1991

   ~We Heard the Angels of Madness: One Family's Struggle with Manic~
   ~Depression.~ Diane and Lisa Berger This book was written by a mother
   who had a son stricken by manic-depression at 19 and documents the
   rough road they walked to get him the help he needed. Very heartfelt
   and well written.

   ~Understanding Depression.~ Donald Klein, MD, and Paul Wender, MD
   (founders of the National Assn. for Depressive Illness). Oxford,
   1993 Melvin Sabshin, MD, Medical Director, American Psychiatric Assn.
   writes: "A very good source of information that will be
   extraordinarily useful to patients and their families."

   ~The Way Up From Down.~ Priscilla Slagle, M.D. This book stresses a
   nutritional approach heavy on the amino acid tyrosine, and a complete
   vitamin supplement program.

   ~What You Need to Know About Psychiatric Drugs.~ Stuart C. Yudofsky,
   MD; Robert E. Hales, MD; and Tom Ferguson, MD. Ballantine. 1991

   ~When am I Going to Be Happy?~ Penelope Russianoff, Ph.D.. Bantam.
   1989

   ~When the Blues Won't Go Away.~ Robert Hirschfeld, MD... 1991 Concerns
   new approaches to Dysthymic Disorder and other forms of chronic
   low-grade depression.

   ~Winter Blues: Seasonal Affective Disorder and How to Overcome It.~
   Norman Rosenthal, MD... The Guilfold Press. 1993

   ~You Are Not Alone.~ Julia Thorne with Larry Rothstein. Harper Collins.
   1993 Comments: The writings of depressives, for both depressives and
   those who need to understand them. Shervert Frazier, MD, former
   director of    the National Institutes of Mental Health says: "A
   ground breaking book that...reveals the impact of depression on the
   lives of everyday people. This little book is must reading for
   sufferers, those associated with depression, and mental health
   professionals"

   ~You Mean I Don't Have To Feel This Way?~ Collette Dowling. Bantam.
   1993 Comments: Jeffrey M. Jonas, MD writes: "An important book that
   is filled with information helpful to sufferers of mood and eating
   disorders and other illnesses. It should be read not only by lay
   people but also by professionals who deal with these illnesses."

..


Archive-name: alt-support-depression/faq/part5
Posting-Frequency: bi-weekly
Last-modified: 1994/08/07


Part 5 of 5
===========

  **Famous People**
   - Who are some famous people who suffer from depression and bipolar
     disorder?

  **Internet Resources**
   - What are some electronic resources on the internet related to
     depression?

  **Anonymous Posting**
   - How can I post anonymously to alt.support.depression?

  **Sources**
   - Sources

  **Contributors**
   - Contributors


Famous People
-------------

Q. Who are some famous people who suffer from depression and bipolar
   disorder?

   This list represents a few of the famous people included in a list
   posted to a.s.d. on a periodic basis. Much of it is taken from the
   book by Kay Redfield Jamison, "Touched With Fire; Manic-Depressive
   Illness and the Artistic Temperament." The Free Press (Macmillan),
   New York, 1993. Used without permission, but with intent to educate,
   and not for profit. Please send updates (or additions) to
   [e-mail]

  "This is meant to be an illustrative rather than a comprehensive
   list... Most of the writers, composers, and artists are American,
   British, European, Irish, or Russian; all are deceased... Many if
   not most of these writers, artists, and composers had other major
   problems as well, such as medical illnesses, alcoholism or drug
   addiction, or exceptionally difficult life circumstances. They are
   listed here as having suffered from a mood disorder because their
   mood symptoms predated their other conditions, because the nature
   and course of their mood and behavior symptoms were consistent with
   a diagnosis of an independently existing affective illness, and/or
   because their family histories of depression, manic-depressive
   illness, and suicide--coupled with their own symptoms--were
   sufficiently strong to warrant their inclusion." (from Touched With
   Fire...)

   KEY:
       H  = Asylum or psychiatric hospital
       S  = Suicide
       SA = Suicide Attempt

   **WRITERS:** Hans Christian Andersen, Honore de Balzac, James Barrie,
   William Faulkner (H), F. Scott Fitzgerald (H), Ernest Hemingway (H,
   S), Hermann Hesse (H, SA), Henrik Ibsen, Henry James, William James,
   Samuel Clemens (Mark Twain), Joseph Conrad (SA), Charles Dickens,
   Isak Dinesen (SA), Ralph Waldo Emerson, Herman Melville, Eugene
   O'Neill (H, SA), Mary Shelley, Robert Louis Stevenson, Leo Tolstoy,
   Tennessee Williams (H), Mary Wollstonecraft (SA), Virginia Woolf
   (H, S)

   **COMPOSERS:** Hector Berlioz (SA), Anton Bruckner (H), George
   Frederic Handel, Gustav Holst, Charles Ives, Gustav Mahler, Modest
   Mussorgsky, Sergey Rachmaninoff, Giocchino Rossini, Robert Schumann
   (H, SA), Alexander Scriabin, Peter Tchaikovsky

   **NONCLASSICAL COMPOSERS AND MUSICIANS:** Irving Berlin (H), Noel
   Coward, Stephen Foster, Charles Mingus (H), Charles Parker (H, SA),
   Cole Porter (H)

   **POETS:** William Blake, Robert Burns, George Gordon, Lord Byron,
   Samuel Taylor Coleridge, Hart Crane (S) , Emily Dickinson, T.S. Eliot
   (H), Oliver Goldsmith, Gerard Manley Hopkins, Victor Hugo, Samuel
   Johnson, John Keats, Vachel Lindsay (S), James Russell Lowell, Robert
   Lowell (H), Edna St. Vincent Millay (H), Boris Pasternak (H), Sylvia
   Plath (H, S), Edgar Allan Poe (SA), Ezra Pound (H), Anne Sexton (H,
   S), Percy Bysshe Shelley (SA), Alfred, Lord Tennyson, Dylan Thomas,
   Walt Whitman

   **ARTISTS:** Richard Dadd (H), Thomas Eakins, Paul Gauguin (SA),
   Vincent van Gogh (H, S), Ernst Ludwig Kirchner (H, S), Edward Lear,
   Michelangelo, Edvard Meunch (H), Georgia O'Keeffe (H), George Romney,
   Dante Gabriel Rossetti (SA)

   **Confirmed Bipolars (still living):** Idi Amin, former dictator;
   Patty Duke (Anna Pearce), actor, writer; Connie Francis, actor,
   musician; Peter Gabriel, musician; Charles Haley, athlete (Dallas
   Cowboys); Kristy McNichols, actor; Spike Mulligan, comic actor;
   Abigail Padgett, mystery writer; Murray Pezim, financier (Canada);
   Charley Pride, musician; Axl Rose, musician; Ted Turner,
   entrepreneur, media giant (U.S.); Robin Williams, actor, comedian

   **Confirmed Unipolars (still living):** Roseanne Arnold, actor,
   writer, comedienne (also has Multiple personality disorder and
   obsessive compulsive disorder); Dick Cavett, writer, media
   personality; Tony Dow, actor, director; Kitty Dukakis, Massachusetts
   first lady; William Styron, writer; James Taylor, musician; Mike
   Wallace, news anchor.


Internet Resources
------------------

Q. What are some electronic resources on the internet related to
   depression?

   This list is a shortened version of one compiled and maintained by
   Sylvia Caras. It is posted periodically to ThisIsCrazy-L (see below
   for subscription information) If you would like to suggest additions
   for this list, contact <[e-mail]> To suggest additions to
   this list for the Alt.support.depression FAQ, send them to
   [e-mail].

   * News groups:
      alt.support.depression
      alt.support.phobias
      sci.psychology
      sci.med
      sci.med.psychobiology

   * Internet Health Resources is an extensive listing of medical
     resources available over the internet.
      ftp2.cc.ukans.edu
      cd pub/hmatrix
      get file medlst03.txt or medlst03.zip.

   * An FTP site at Temple University containing articles related to
     depression
      ftp 129.32.32.98
      cd/pub/psych

   * ThisIsCrazy is an electronic action and information letter for
     people who experience moods swings, fright, voices, and visions
     (People Who). To subscribe, send a message to [e-mail]
     with this command in the body of the message:
      subscribe ThisIsCrazy-L

   * Pendulum is a mailing list for people diagnosed with bipolar mood
     disorder (manic depression) and related disorders and their
     supporters, and some professionals. To subscribe to pendulum, send
     a message to [e-mail] containing the line
      subscribe pendulum

   * Walkers-in-Darkness is a list for people diagnosed with various
     depressive disorders (unipolar, atypical, and bipolar depression,
     S.A.D., related disorders). The list also includes sufferers of
     panic attacks and Borderline Personality Disorder. Please, no
     researchers trying to study us, etc. (Postings are copyrighted by
     individual posters.)

     To subscribe to walkers or walkers-digest, send a message to
     [e-mail] containing the line "subscribe walkers" or,
     for the digest, "subscribe walkers-digest". There is an anonymous
     FTP site at ftp.std.com in ~/pub/walkers, that includes a technical
     FAQ.

   * To subscribe to the Mailbase list psychiatry send the command
     SUBSCRIBE psychiatry <your name> to [e-mail]


Q. How can I post anonymously to alt.support.depression?

   You can post anonymously to alt.support.depression by using the
   anonymous server in Finland. For more information about the anonymous
   server, send mail to [e-mail] for an automated reply that
   explains how to use the server. Special note While your posting will
   appear in alt.support.depression without any indication of your
   identity, your posting first has to be sent to Finland by e-mail. This
   makes the contents of your message no more secure than any other
   international e-mail (less secure if you don't trust the administrator
   of anon.penet.fi), which is to say not very secure at all. For more
   information, consult the Privacy & Anonymity on the Internet FAQ,
   posted regularly to sci.crypt, comp.society.privacy, and alt.privacy.


Sources
-------

   Pamphlet: Depression: What you need to know, National Institute of
   Mental Heath. By Marilyn Sargent. Office of Scientific Information
   National Institute of Mental Health

   Diagnostic and Statistical Manual of Mental Disorders. The DSM stands
   for the Diagnostic and Statistical Manual of Mental Disorders. It is
   published by the American Psychiatric Association. The latest version
   is the DSM-III-R (1987). For reference, the DSM-III was published in
   1980.
   The first edition of this manual was published in 1952, and the
   second edition in 1968. The fourth edition (DSM-IV) is currently in
   press and should be available this summer. It is used by the vast
   majority of psychologists and mental health professionals in the
   United States of America as a diagnostic tool. Psychiatrists and
   professionals outside of the U.S. will often use a diagnostic system
   called ICD-9, which differs in many respects from the DSM.


Contributors
------------

  Becky <[e-mail]> Elmont,NY
  Brian Gerred <[e-mail]>
  Dawn Sharon Friedman <[e-mail]>
  Dana Quinn <[e-mail]>
  John M. Grohol ([e-mail]), Nova S.E. University
  Joy Ikelman <[e-mail]> Boulder, CO
  [e-mail] (Keith Rich)
  Mary-Anne Wolf <[e-mail]>
  Rachel Findley
  Robert Orenstein ([e-mail])
  Silja Muller <[e-mail]>
  Stephan Klaus Heilmayr <[e-mail]> Oakland, CA
  Sue W. <[e-mail]>
  Sylvia Caras <[e-mail]> Owner, ThisIsCrazy-L
  Todd Daniel Woodward <[e-mail]> Mountain View, CA
  Wes Melander <[e-mail]>

Editor: Cynthia Frazier ([e-mail]) Lansing, NY

Special thanks to Ivan Goldberg, MD, NY Psychopharmacologic
Inst,.<[e-mail]>, who has provided many of the questions and
answers as well as made corrections throughout the FAQ.

..